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Deshmukh A, Elmeligui A, Parsa N, Tejedor-Tejada J, Nieto J. Successful removal of a giant esophageal lipoma with hybrid endoscopic submucosal dissection. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:398-400. [PMID: 34527835 PMCID: PMC8431273 DOI: 10.1016/j.vgie.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Endoscopic submucosal dissection of a giant esophageal lipoma.
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Affiliation(s)
- Ameya Deshmukh
- Department of Internal Medicine, Saint Louis University - SOM, St. Louis, Missouri
| | - Ahmed Elmeligui
- Division of Gastroenterology, Hepatology and Endoscopy, Kasr Alainy School of Medicine, Cairo, Egypt
| | - Nasim Parsa
- Division of Gastroenterology and Hepatology, University of Missouri Health System, Columbia, Missouri
| | - Javier Tejedor-Tejada
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida
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Obeidat Y, Simmons J, AlTarawneh S, Sigdel S, Frandah W, Saunders E. A Benign Ulcerating Gastric Mass Presenting as Acute Gastrointestinal Hemorrhage. Cureus 2021; 13:e15954. [PMID: 34336450 PMCID: PMC8314799 DOI: 10.7759/cureus.15954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 11/05/2022] Open
Abstract
Gastrointestinal lipomas are rare, often colonic tumors. The stomach is an unusual site of involvement of lipomas, accounting for less than 5% of all gastrointestinal lipomas and less than 3% of all benign gastric neoplasms. They are usually asymptomatic, and symptoms develop as the tumor grows. Gastric lipomas can present with massive bleeding from an ulcerating tumor and can be life-threatening if left untreated. We present a case of an ulcerating gastric lipoma that presented as an acute upper gastrointestinal hemorrhage. The patient was treated with Billroth II procedure and final pathology showed an ulcerating submucosal lipoma. The diagnosis of gastric lipoma is often suspected incidentally on imaging, then confirmed via biopsy. Definitive treatment of large lesions typically requires surgery, however, newer endoscopic techniques are being utilized for resection of these benign tumors.
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Affiliation(s)
- Yasmeen Obeidat
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Joseph Simmons
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Saba AlTarawneh
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Saroj Sigdel
- Pathology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Wesam Frandah
- Gastroenterology and Hepatology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Elizabeth Saunders
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Experience with Esophageal Granular Cell Tumors: Clinical and Endoscopic Analysis of 22 Cases. Dig Dis Sci 2021; 66:1233-1239. [PMID: 32474763 DOI: 10.1007/s10620-020-06337-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/09/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Esophageal granular cell tumors (GCTs) are rare tumors. Differences in reports on the clinical features of GCTs in the esophagus and some controversies about the diagnostic strategy for esophageal GCTs exist. OBJECTIVES We aimed to investigate the clinical features and diagnosis of esophageal GCTs. Additionally, we sought to determine the prevalence of gastroesophageal reflux disease and reflux esophagitis in patients with esophageal GCTs. METHODS We retrospectively studied the clinical features, endoscopic features, and management of 22 patients with esophageal GCTs. RESULTS Esophageal GCTs were more common in men than in women with a ratio of 1.2:1 and were predominantly found in the distal esophagus. Ten patients with esophageal GCTs had regurgitation and/or heartburn symptoms, and eight patients were confirmed to have reflux esophagitis by endoscopy. All esophageal GCTs were protuberant lesions covered by normal esophageal epithelium. The endoscopic morphology of esophageal GCTs was diverse. On endoscopic ultrasonography, these tumors appeared as homogeneous or inhomogeneous hypoechoic lesions with clear borders originating from the submucosal or mucosal layer. Eleven patients underwent endoscopic forceps biopsy at the first endoscopy, and only six patients were correctly diagnosed by pathology. Nevertheless, the 18 lesions treated with endoscopic resection were all correctly diagnosed without complications, and no patients developed recurrence during the follow-up period. CONCLUSIONS The occurrence of esophageal GCTs may be related to esophageal inflammation. As a method for obtaining an accurate pathological diagnosis and for treatment, endoscopic resection should be offered as the primary option for patients with esophageal GCTs.
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Ferrari D, Bernardi D, Siboni S, Lazzari V, Asti E, Bonavina L. Esophageal Lipoma and Liposarcoma: A Systematic Review. World J Surg 2021. [PMID: 33026474 DOI: 10.1007/s00268-020-05789-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND Esophageal lipomatous tumors, also reported as fibrovascular polyp, fibrolipoma, angiolipoma, and liposarcoma, account for less than 1% of all benign mesenchymal submucosal tumors of the esophagus. Clinical presentation and therapy may differ based on location, size, and morphology. A comprehensive and updated systematic review of the literature is lacking. METHODS A systematic review of the literature was performed according to PRISMA guidelines. Pubmed, Embase, Cochrane, and Medline databases were consulted using MESH keywords. Non-English written articles and abstracts were excluded. Sex, age, symptoms at presentation, diagnosis, tumor location and size, surgical approach and technique of excision, pathology, and morphology were extracted and recorded in an electronic database. RESULTS Sixty-seven studies for a total of 239 patients with esophageal lipoma or liposarcoma were included in the qualitative analysis. Among 176 patients with benign lipoma, the median age was 55. The main symptoms were dysphagia (64.2%), transoral polyp regurgitation (32.4%), and globus sensation (22.7%). The majority of lipomas (85.7%) were intraluminal polyps, with a stalk originating from the upper esophagus. Overall, 165 patients underwent excision of the mass through open surgery (65.5%), endoscopy (27.9%), or laparoscopy/thoracoscopy (3.6%). Only 5 (3%) of patients required esophagectomy. Of the 11 untreated patients with an intraluminal polyp, 7 died from asphyxia. Overall, liposarcoma was diagnosed in 63 patients, and 12 (19%) underwent esophagectomy. CONCLUSION Esophageal lipomatous tumors are rare but potentially lethal when are intraluminal and originate from the cervical esophagus. Modern radiological imaging has improved diagnostic accuracy. Minimally invasive transoral and laparoscopic/thoracoscopic techniques represent the therapeutic approach of choice.
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Affiliation(s)
- Davide Ferrari
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, 20133, Milan, Italy.,Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Daniele Bernardi
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Stefano Siboni
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Veronica Lazzari
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Emanuele Asti
- Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, 20133, Milan, Italy. .,Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan, San Donato Milanese, 20097, Milan, Italy.
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Abstract
Background Esophageal lipomatous tumors, also reported as fibrovascular polyp, fibrolipoma, angiolipoma, and liposarcoma, account for less than 1% of all benign mesenchymal submucosal tumors of the esophagus. Clinical presentation and therapy may differ based on location, size, and morphology. A comprehensive and updated systematic review of the literature is lacking. Methods A systematic review of the literature was performed according to PRISMA guidelines. Pubmed, Embase, Cochrane, and Medline databases were consulted using MESH keywords. Non-English written articles and abstracts were excluded. Sex, age, symptoms at presentation, diagnosis, tumor location and size, surgical approach and technique of excision, pathology, and morphology were extracted and recorded in an electronic database. Results Sixty-seven studies for a total of 239 patients with esophageal lipoma or liposarcoma were included in the qualitative analysis. Among 176 patients with benign lipoma, the median age was 55. The main symptoms were dysphagia (64.2%), transoral polyp regurgitation (32.4%), and globus sensation (22.7%). The majority of lipomas (85.7%) were intraluminal polyps, with a stalk originating from the upper esophagus. Overall, 165 patients underwent excision of the mass through open surgery (65.5%), endoscopy (27.9%), or laparoscopy/thoracoscopy (3.6%). Only 5 (3%) of patients required esophagectomy. Of the 11 untreated patients with an intraluminal polyp, 7 died from asphyxia. Overall, liposarcoma was diagnosed in 63 patients, and 12 (19%) underwent esophagectomy. Conclusion Esophageal lipomatous tumors are rare but potentially lethal when are intraluminal and originate from the cervical esophagus. Modern radiological imaging has improved diagnostic accuracy. Minimally invasive transoral and laparoscopic/thoracoscopic techniques represent the therapeutic approach of choice.
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Bernardi D, Ferrari D, Siboni S, Porta M, Bruni B, Bonavina L. Minimally invasive approach to esophageal lipoma. J Surg Case Rep 2020; 2020:rjaa123. [PMID: 32760482 PMCID: PMC7394138 DOI: 10.1093/jscr/rjaa123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/10/2020] [Indexed: 12/25/2022] Open
Abstract
Esophageal lipoma is a rare neoplasm with heterogeneous and sometimes life-threatening clinical presentation. We report the case of two patients, a 77-year-old man and a 69-year-old woman presenting with heartburn and dysphagia, and with recurrent vomiting and asphyxia, respectively. Upper gastrointestinal endoscopy and computed tomography were highly suggestive of the diagnosis of esophageal lipoma and identified an intramural and an intraluminal pedunculated mass originating, respectively, from the distal and the cervical esophagus. The first patient was treated by laparoscopic transhiatal enucleation and the second by transoral endoscopic resection under general anesthesia. Both had an uneventful postoperative course and were discharged home on postoperative day 2. Minimally invasive excision of esophageal lipoma is feasible and effective. It may be life-saving in patients with pedunculated tumors who suffer from intermittent regurgitation of a bulky polypoid mass in the mouth causing asphyxia.
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Affiliation(s)
- Daniele Bernardi
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Davide Ferrari
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Stefano Siboni
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Matteo Porta
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
| | - Barbara Bruni
- Pathology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Bonavina
- University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, Milano, Italy
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Businello G, Dal Pozzo CA, Sbaraglia M, Mastracci L, Milione M, Saragoni L, Grillo F, Parente P, Remo A, Bellan E, Cappellesso R, Pennelli G, Michelotto M, Fassan M. Histopathological landscape of rare oesophageal neoplasms. World J Gastroenterol 2020; 26:3865-3888. [PMID: 32774063 PMCID: PMC7385561 DOI: 10.3748/wjg.v26.i27.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/19/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
The landscape of neoplastic pathology of the oesophagus is dominated by malignancies of epithelial origin, in particular by oesophageal adenocarcinoma and oesophageal squamous cell carcinoma. However, several other histopathological variants can be distinguished, some associated with peculiar histopathological profiles and prognostic behaviours and frequently underrecognized in clinical practice. The aim of this review is to provide a comprehensive characterization of the main morphological and clinical features of these rare variants of oesophageal neoplastic lesions.
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Affiliation(s)
- Gianluca Businello
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Carlo Alberto Dal Pozzo
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Marta Sbaraglia
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Luca Mastracci
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Massimo Milione
- Department of Pathology and Laboratory Medicine, First Pathology Division, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Luca Saragoni
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Federica Grillo
- Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genova, Genova 16123, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo 71013, Italy
| | - Andrea Remo
- Department of Pathology, Ospedale Mater Salutis di Legnago, Legnago 37045, Italy
| | - Elena Bellan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Rocco Cappellesso
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Gianmaria Pennelli
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Mauro Michelotto
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua 35121, Italy
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Successful removal of a giant esophageal lipoma by thoracoscopic enucleation: a case report. Surg Case Rep 2020; 6:20. [PMID: 31932979 PMCID: PMC6957579 DOI: 10.1186/s40792-020-0782-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background We report a rare case of giant esophageal lipoma treated with thoracoscopic enucleation successfully. Case presentation A 69-year-old woman was referred to our department with dysphagia. Computed tomography examination revealed a large hypoattenuating submucosal mass with dense fat in the middle and lower esophagus. Upper gastrointestinal endoscopy revealed a submucosal mass with normal mucosa on the middle and lower esophageal wall. On a diagnosis of esophageal lipoma, we performed a video-assisted thoracoscopic operation and the 14.0 × 6.5 × 3.0 cm in size submucosal tumor was completely enucleated. We could successfully avoid a subtotal esophagectomy with high invasiveness. The patient was discharged on the 36th day after operation, and no symptoms had been noted. Conclusions Video-assisted thoracoscopic enucleation with minimal invasiveness may be an appropriate treatment option even for such a huge benign esophageal submucosal tumor.
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How CH, Lee JM. The robotic approach for enucleation of a giant esophageal lipoma. J Robot Surg 2016; 11:267-269. [PMID: 28005192 DOI: 10.1007/s11701-016-0668-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
An 87-year-old man, who had been experiencing progressive dysphagia and slight chest discomfort for 12 months, presented for an esophagram with a diagnosis of achalasia. A giant esophageal lipoma (14.5- × 4.5- × 3.5-cm) that caused symptomatic dysphagia and a dilated esophagus was revealed by computed tomography and endoscopic esophageal ultrasound. For such a huge esophageal lipoma in a geriatric patient, we successfully enucleated the mediastinal lesion via a minimally invasive approach using the da Vinci S Surgical System.
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Affiliation(s)
- Cheng-Hung How
- Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Jang-Ming Lee
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
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Sestini S, Gisabella M, Pastorino U, Billé A. Presenting symptoms of giant fibrovascular polyp of the oesophagus: case report and literature review. Ann R Coll Surg Engl 2016; 98:e71-3. [PMID: 27087340 PMCID: PMC5227043 DOI: 10.1308/rcsann.2016.0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Lipomas of the gastrointestinal tract are rare, slow-growing lesions that comprise 0.4% of all gastrointestinal neoplasms. They can cause dysphagia, dyspnoea or sudden choking. CASE HISTORY Due to rarity of this condition and its uncommon presentation, a literature review was carried out (PubMed). This search revealed 290 articles, of which 74 were considered pertinent and were evaluated. We report a case of a 13cm pedunculated oesophageal lipoma that presented with increasing dysphagia and two episodes of suffocation. The patient underwent curative resection through a cervical approach. CONCLUSIONS Resection is recommended for large (>5 cm) or symptomatic polyps. Outcomes are excellent given that lesions are universally benign and oesophageal resection is not required.
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Affiliation(s)
- S Sestini
- Fondazione IRCCS, Istituto Nazionale dei Tumori , Milan , Italy
| | - M Gisabella
- Fondazione IRCCS, Istituto Nazionale dei Tumori , Milan , Italy
| | - U Pastorino
- Fondazione IRCCS, Istituto Nazionale dei Tumori , Milan , Italy
| | - A Billé
- Thoracic Surgery at Guys Hospital , UK
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